Death Bed-side Discussions: Delusional or Divine?
Rajan Dewar, M.D., Ph.D., Associate Professor of Pathology, University of Michigan
Death, despite it’s inevitability as an outcome of life, is a challenging prospect to face by a patient, family members and providers. Many individuals and families suffering with the inevitability of death in their near term, develop coping mechanisms. Of the coping mechanisms, religious and spiritual beliefs provide ways to tide over emotional suffering associated with death. This paper illustrates this with a real case example and lists a few practical challenges in utilizing religious principles in death bed side discussions in current day medicine.
Patient example: Master Langley was an energetic and engaging ~3 year old healthy boy, when he developed abdominal distension and was diagnosed with malignant neuroblastoma. Therapy helped with initial remissions, but eventually he developed widespread metastatic disease, when he was 7. The parents had the unfortunate task of preparing Master Langley towards his eventual demise, which happened when he was 9. Christians by birth, the mother Langley resorted to religious principles as she talked to her son about his own death when he was 7-9 years old.
Master Langley was familiar with the concept of heaven as a possible destiny for departed souls (“dead people”). Mrs. Langley had several discussions with her son about the nature of heaven and had “orientations” for him. Mrs. Langley’s creative language, and convincing descriptions of heaven made Master Langley somewhat comfortable as he confronted death and the suffering associated with emotional tragedy of separation. He had several questions that his mom comfortably answered (example – “How will I find you, after you die and reach heaven later?”).
The “concept” of after-life finds no place in the scientific practice of medicine and utilizing religious principles in care giving has no formal acceptance by physicians. These ‘tasks’ are ‘delegated’ to spiritual care providers. Thus while questions about a disease and treatment, are addressed by physicians, doctors struggle with end-of-life conversations and religious guiding principles. While most physicians are accommodative with the terminally ill, some physicians face a conflict of religious beliefs and scientific principles or their own religious beliefs against the belief of their patients.
Questions about heaven by a patient to an agnostic scientist physician care-provider may not be answered comfortably. Such ‘non-scientific’ beliefs may appear absurd and descriptions interpreted as delusional by an unprepared or a non-believing physician. However, these coping mechanisms are very practical and important in patients and families as they face crises.
Additionally, eastern religions and Abrahamic traditions have different concepts of after-life. Thus a physician of Jewish faith may not agree with the peaceful passing to the next life of a Hindu or Buddhist patients. Finally, while after-life seems to be an abstract and non-scientific, should there be considerations by governmental agencies to explore the religious principles and the role after life discussions play in caregiving, necessitating additional funding? The search for extra-terresterial life is a close example, which despite lack of initial scientific evidence had received governmental support and funding.
In summary, the role of religion and patient’ spiritual beliefs in care giving and coping mechanisms should be explored further.
Death, despite it’s inevitability as an outcome of life, is a challenging prospect to face by a patient, family members and providers. Many individuals and families suffering with the inevitability of death in their near term, develop coping mechanisms. Of the coping mechanisms, religious and spiritual beliefs provide ways to tide over emotional suffering associated with death. This paper illustrates this with a real case example and lists a few practical challenges in utilizing religious principles in death bed side discussions in current day medicine.
Patient example: Master Langley was an energetic and engaging ~3 year old healthy boy, when he developed abdominal distension and was diagnosed with malignant neuroblastoma. Therapy helped with initial remissions, but eventually he developed widespread metastatic disease, when he was 7. The parents had the unfortunate task of preparing Master Langley towards his eventual demise, which happened when he was 9. Christians by birth, the mother Langley resorted to religious principles as she talked to her son about his own death when he was 7-9 years old.
Master Langley was familiar with the concept of heaven as a possible destiny for departed souls (“dead people”). Mrs. Langley had several discussions with her son about the nature of heaven and had “orientations” for him. Mrs. Langley’s creative language, and convincing descriptions of heaven made Master Langley somewhat comfortable as he confronted death and the suffering associated with emotional tragedy of separation. He had several questions that his mom comfortably answered (example – “How will I find you, after you die and reach heaven later?”).
The “concept” of after-life finds no place in the scientific practice of medicine and utilizing religious principles in care giving has no formal acceptance by physicians. These ‘tasks’ are ‘delegated’ to spiritual care providers. Thus while questions about a disease and treatment, are addressed by physicians, doctors struggle with end-of-life conversations and religious guiding principles. While most physicians are accommodative with the terminally ill, some physicians face a conflict of religious beliefs and scientific principles or their own religious beliefs against the belief of their patients.
Questions about heaven by a patient to an agnostic scientist physician care-provider may not be answered comfortably. Such ‘non-scientific’ beliefs may appear absurd and descriptions interpreted as delusional by an unprepared or a non-believing physician. However, these coping mechanisms are very practical and important in patients and families as they face crises.
Additionally, eastern religions and Abrahamic traditions have different concepts of after-life. Thus a physician of Jewish faith may not agree with the peaceful passing to the next life of a Hindu or Buddhist patients. Finally, while after-life seems to be an abstract and non-scientific, should there be considerations by governmental agencies to explore the religious principles and the role after life discussions play in caregiving, necessitating additional funding? The search for extra-terresterial life is a close example, which despite lack of initial scientific evidence had received governmental support and funding.
In summary, the role of religion and patient’ spiritual beliefs in care giving and coping mechanisms should be explored further.